摘要
目的探讨颅脑损伤(TBI)后脑脊液中聚集素蛋白(CLU)与血清神经元特异性烯醇化酶(NSE)及神经功能预后的关系。方法选取2019年9月至2021年10月嘉兴市第二医院神经外科和神经重症病房连续性收治的144例急性TBI患者为研究对象,其中2019年9月至2020年9月收治的76例患者为观察A组,2020年10月至2021年10月收治的68例患者为观察B组。选择同期本院收治的68例非TBI患者为对照组。检测观察A组患者伤后24、48、72、96 h及对照组入院24 h内血清CLU及NSE水平,确定伤后GLU水平达峰时点。采用Pearson相关分析伤后72 h观察A组患者血清及观察B组脑脊液CLU水平与格拉斯哥昏迷评分(GCS)、血清NSE水平及鹿特丹CT评分的相关性;采用Spearman秩相关分析观察B组患者伤后1个月格拉斯哥预后评分(GOS)与脑脊液CLU水平、GCS、鹿特丹CT评分的相关性,采用多元线性回归分析伤后1个月神经功能预后的影响因素。结果与对照组比较,观察A组患者伤后48、72、96 h血清CLU及NSE水平均明显升高(均P<0.05),其中伤后72 h达到峰值(均P<0.05)。观察A组患者血清CLU水平与GCS、血清NSE水平、鹿特丹CT评分均无相关性(均P>0.05);观察B组患者脑脊液CLU水平与GCS呈负相关(r=-0.777,P<0.05),与血清NSE水平、鹿特丹CT评分均呈正相关(r=0.707、0.600,均P<0.05)。观察B组患者伤后1个月GOS为4(3,5)分,其与脑脊液CLU水平、鹿特丹CT评分均呈负相关(r_(s)=-0.845、-0.701,均P<0.05),与GCS呈正相关(r_(s)=0.898,P<0.05)。脑脊液CLU水平、GCS、鹿特丹CT评分均是伤后1个月神经功能预后的影响因素(均P<0.05)。结论TBI后检测72 h脑脊液CLU水平有助于评估患者TBI严重程度及神经功能预后。
Objective To explore the relationship between clusterin(CLU)in cerebrospinal fluid,serum neuron specific enolase(NSE),and neurological prognosis after traumatic brain injury(TBI).Methods One hundred and forty-four consecutive patients with acute TBI admitted to the Neurosurgery and Neurology Intensive Care Unit of Jiaxing Second Hospital from September 2019 to October 2021 were selected as the study subjects.Among them,76 patients admitted from September 2019 to September 2020 were selected as observation group A,and 68 patients admitted from October 2020 to October 2021 were selected as observation group B.Another 68 patients without TBI admitted to our hospital during the same period were selected as the control group.Detect the serum CLU and NSE levels of patients in Group A 48,72,and 96 hours after TBI and compare those with the control group within 24 h after admission to determine the peak time point of GLU level after injury.Pearson correlation analysis was used to investigate the relationship of serum GLU level of Group A and cerebrospinal fluid CLU level of Group B 72 h after injury with Glasgow Coma Scale(GCS)scores,serum NSE levels,and Rotterdam CT scores;The relationships between Glasgow Outcome Scale(GOS)scores of Group B one month after TBI and cerebrospinal fluid CLU level,GCS score,and Rotterdam CT score were analyzed using Spearman rank correlation;The multiple linear regression was used to analyze influencing factors for neurological prognosis one month after injury.Results Compared with the control group,the serum CLU and NSE levels in Group A patients were significantly increased at 24,48,72,and 96 hours after TBI(all P<0.05),with a peak at 72 hours after injury(all P<0.05).There was no correlation between the serum CLU level and GCS,serum NSE level,and Rotterdam CT score in Group A patients(all P>0.05);The CLU level in cerebrospinal fluid of Group B was negatively correlated with GCS(r=-0.777,P<0.05),and positively correlated with serum NSE level and Rotterdam CT score(r=0.707,0.600,both P<0.05).The GOS score of Group B patients at 1 month after TBI was 4(3,5),which was negatively correlated with cerebrospinal fluid CLU level and Rotterdam CT score(r_(s)=-0.845,-0.701,both P<0.05),and positively correlated with GCS(r_(s)=0.898,P<0.05).Cerebrospinal fluid CLU level,GCS,and Rotterdam CT score are all influencing factors for neurological prognosis at 1 month after TBI(all P<0.05).Conclusion The detection of cerebrospinal fluid CLU levels 72 hours after TBI can help evaluate the severity of TBI and the prognosis of neurological function of patients.
作者
田和平
钟琦
王耿焕
周海航
TIAN Heping;ZHONG Qi;WANG Genghuan;ZHOU Haihang(Department of Neurosurgery,Jiaxing Second Hospital,Jiaxing 314000,China)
出处
《浙江医学》
CAS
2023年第21期2294-2297,2302,共5页
Zhejiang Medical Journal
基金
嘉兴市科技计划项目(2019AD32193)。
